Abstract
Background: Postnatal corticosteroids to treat ventilator-dependent infants are associated with adverse neurological sequelae in childhood, especially cerebral palsy, but may save lives. Corticosteroids may be beneficial in infants at very high risk of chronic lung disease (CLD).
Aims: To determine if a low-dose, short course, of dexamethasone given after the first week of life affects survival free of cerebral palsy (CP) at 2 years of age.
Methods: Very preterm (<28 weeks) or extremely low birthweight (birthweight <1000 g) ventilator-dependent infants after the first week of life and in whom the clinician thought steroids were clinically indicated were eligible. Infants were randomly allocated to receive either a 10-day tapering course of low-dose dexamethasone (0.89 mg/kg total over 10-days), or an identical volume of saline placebo. Surviving children were assessed at 2 years of age, corrected for prematurity, by paediatricians and psychologists blinded to treatment group allocation.
Results: Thirty-five infants were randomly allocated to each group. The rate of CLD in the control group was >80%. Mortality rates were not substantially different between the 2 groups (dexamethasone 11%, controls 20%; OR 0.52, 95% CI 0.14, 1.95; P=0.32), and the rates of cerebral palsy were 11% in the dexamethasone group and 17% in the control group. There was not a clear-cut difference in the combined rate of death or cerebral palsy (dexamethasone 23%, placebo 37%; OR 0.50, 95% CI 0.15, 1.60). The reduction in the combined outcome of death or cerebral palsy in this cohort at very high risk of CLD was consistent with the results of a recent metanalysis of randomised trials of postnatal corticosteroids (Pediatrics 2005:115; 655–661).
Conclusions: The long-term effects of dexamethasone in infants at high risk of CLD may not be universally detrimental.
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Doyle, L., Davis, P., Morley, C. et al. 100 Low Dose Dexamethasone in Chronically Ventilator-Dependent Infants and Survival Free of Cerebral Palsy in Early Childhood. The Dart Study. Pediatr Res 58, 371 (2005). https://doi.org/10.1203/00006450-200508000-00129
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DOI: https://doi.org/10.1203/00006450-200508000-00129